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Community palliative medicine out-of-hours needs and the 7-day week: a service evaluation
  1. Matthew Doré1 and
  2. Derek Willis2
  1. 1 Palliative Care, Severn Hospice, Telford, UK
  2. 2 Medical, Severn Hospice, Telford, UK
  1. Correspondence to Dr Matthew Doré, Palliative Care, Severn hospice, Telford TF1 6RH, UK; mattsharondore{at}gmail.com

Abstract

Background Evidence regarding out-of-hours (OOH) community palliative care provision is required to inform the need for a 7-day work.

Aim This paper seeks to provide evidence for this discussion by defining general practitioners’ (GPs) OOH workload and patients’ demographics, symptomology and interventions. By quantifying the challenges faced, we can understand current practice and focus on what provision is required.

Design Using Shropshire Doctors Co-operative’s recorded data, the authors have collated a representative picture of the OOH GP palliative care practice over a year from 161 OOH GP–patient interactions.

Setting Primary care.

Results Palliative care makes up 11.4% of the total OOH GP home visits (HV). Overall 56% of OOH GP HVs are for patients who are expected to die within 48 hours, with 80% of the symptoms being agitation, secretions and pain. Overall 5.7% of OOH GP palliative HVs resulted in hospital admission; however, this decreased to 0.6% adjusting for the last 48-hour prognosis.

Conclusion OOH Shropshire GPs deal with a wide variety of scenarios in a heterogeneous population. The greatest demand is from 17:00 to 00:00 (65% of the total shift) on weekdays, and from 09:00 to 00:00 on weekends (82% of the shift). These data begin to quantify the role being performed by OOH GPs, have implications for service provision and support 7-day work.

  • service evaluation
  • home care

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Footnotes

  • Contributors MD, Palliative Care StR, designed and planned the study, discussed with Shropdoc, and collected, analysed and presented the data. DW oversaw the whole project, gave advice throughout, and did detailed suggestions and edits.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Contacted the Royal Wolverhampton NHS trust research ethics committee and received the following email on the 20/09/17. This study was classed as service provision and thus does not need ethics approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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